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Fabijanic, Vrsalovic, and Lojpur: Lipomatous Hypertrophy of the Interatrial Septum: A 3-Dimensional Transesophageal Echocardiography Appearance
Images in Cardiovascular Ultrasound

Journal of Cardiovascular Ultrasound 2015; 23(4): 274-275.

Published online: 30 December 2015

DOI: https://doi.org/10.4250/jcu.2015.23.4.274

Lipomatous Hypertrophy of the Interatrial Septum: A 3-Dimensional Transesophageal Echocardiography Appearance

Damir Fabijanic, MD, PhD1, Mislav Vrsalovic, MD, PhD2, 3, Mihajlo Lojpur, MD, PhD4

1Department of Cardiology, University Hospital Centre Split, Split, Croatia.

2Department of Cardiology, University Hospital Centre Sisters of Mercy, Zagreb, Croatia.

3School of Medicine, University of Zagreb, Zagreb, Croatia.

4Department of Anesthesiology, University Hospital Centre Split, Split, Croatia.

Address for Correspondence: Damir Fabijanic. Department of Cardiology, University Hospital Centre Split, 1 Spinciceva, Split 21000, Croatia. Tel: +385-21-556-766, Fax: +385-21-556-031, damir.fabijanic@st.t-com.hr

Received 21 April 2015       Revised 16 May 2015       Accepted 18 November 2015

Copyright © 2015 Korean Society of Echocardiography

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Keywords: Lypomatous hypertrophy, Interatrial septum, Echocardiography

Lipomatous hypertrophy of the interatrial septum (LHIS) is a benign cardiac disorder characterized by massive fatty deposits in the interatrial septum.1)2)3) Although the precise etiology is unknown, it has been suggested that LHIS is associated with obesity and aging.1)2) Mostly asymptomatic, LHIS is usually an incidental finding which does not require any specific treatment. Surgical management should be considered very rare, in patients with intractable severe rhythm disorders, hemodynamic instability, symptoms of superior vena cava syndrome or right atrium obstruction.1)2)3) Despite the fact that to date more than 200 cases have been published, LHIS remains under recognized and frequently misdiagnosed as a malignant tumor. Therefore, recognition of this lesion, with reported incidence of up to 8%, is of highest importance.1)2)
A 72-year-old asymptomatic obese woman (body mass index = 29 kg/m2) referred to our cardiology department because transthoracic echocardiography showed a right atrial mass highly suspicious of a tumor. Echocardiographic findings suggestive for LHIS were revealed by 2-dimensional and real time 3-dimensional transesophageal echocardiography (RT3DTEE). Moreover, as it is shown in Fig. 1, the advantage of RT3DTEE is the possibility of detailed and accurate spatial visualization of cardiac structures which enabled diagnosis of LHIS without using other imaging techniques (e.g., computed tomography, cardiac magnetic resonance imaging) or tissue biopsy.

Figures and Tables

Fig. 1

2D (A) and 3D (B and C) transesophageal echocardiography appearance of lipomatous hypertrophy of the interatrial septum (IAS, asterisks) can be summarized as: 1) IAS thickening > 2 cm, 2) a projection of the mass only into the right atrium, 3) a homogenous appearance of the mass, 4) sparing the membrane of the fossa ovalis (arrows) that, in case of affecting proximal and distal part of IAS, might result in characteristic bilobal (dumbbell shape) IAS appearance. LA: left atrium, RA: right atrium, SVC: superior vena cava, IVC: inferior vena cava.

jcu-23-274-g001

References

1. Heyer CM, Kagel T, Lemburg SP, Bauer TT, Nicolas V. Lipomatous hypertrophy of the interatrial septum: a prospective study of incidence, imaging findings, and clinical symptoms. Chest. 2003; 124:2068–2073.
2. O'Connor S, Recavarren R, Nichols LC, Parwani AV. Lipomatous hypertrophy of the interatrial septum: an overview. Arch Pathol Lab Med. 2006; 130:397–399.
3. Xanthos T, Giannakopoulos N, Papadimitriou L. Lipomatous hypertrophy of the interatrial septum: a pathological and clinical approach. Int J Cardiol. 2007; 121:4–8.
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